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Quick Tip for Families in Intensive Care: Wikipedia Page Confirms that LTACs (Long-Term Acute Care) in the U.S. are Not Fit for Purpose for Ventilated ICU Patients!

If you want to know more about why you should avoid LTACs in the United States, stay tuned! I’ve got a great video for you coming today.

My name is Patrik Hutzel with another quick tip for families in intensive care. Today is a video for our U.S. audience specifically, today I want to talk more about why you should avoid LTAC or long-term acute care facilities at all costs.

So, a couple of weeks ago, I did a YouTube live where I was talking about 10 reasons why LTACs are a scam, and you can watch that video and I’ll put a link below this video. Now, I’ve been blogging about this for years that LTAC in the U.S. are a complete scam.

Now, I had a reader reach out and say, “What is an LTAC?” and obviously got explained in my other video, but I just thought I need to do more deep diving here because it seems to be still not clear what an LTAC actually is in the U.S.

So, I read out the long-term acute care facility explanation on Wikipedia and there is more evidence on that Wikipedia page actually why I’m saying you should not go to an LTAC. So many patients in intensive care in the U.S. that end up with a tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) tube end up in LTAC, going from ICU to LTAC. Now, I’ve been saying for the longest that LTACs are not even the better version of a nursing home and that you should fight tooth and nail not to go to LTAC.

There are proven strategies to avoid it, that’s what we’ve been doing here at intensivecarehotline.com for many years, getting results for our clients and you can look up those results on our testimonial section or on our podcast section where we’ve done client interviews.

So, let’s read out the Wikipedia page of what long-term acute care facility is, an LTAC, and also what Wikipedia says about the environment they’re operating in, the results they’re getting, and patient and family feedback:

“A long-term acute care hospital (LTACH), also known as a long-term care hospital (LTCH), is a hospital specializing in treating patients requiring extended hospitalization. Hospitals specializing in long-term care have existed for decades in the form of sanatoriums for patients with tuberculosis and other chronic diseases. The modern hospital known as an LTACH came into existence as a result of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999. The Act defines an LTACH as ‘a hospital which has an average inpatient length of stay (as determined by the Secretary of Health and Human Services) of greater than 25 days. Traditionally, LTACHs provide care for patients receiving prolonged mechanical ventilation,” which is what I said in the beginning that many patients in intensive care are pushed out to LTAC once they have a tracheostomy and a PEG tube.

The Wikipedia page continues.

“LTACHs have a diverse set of characteristics which influence the ways in which they operate. Physically, LTACHs exist in two models, hospital within hospital or free-standing. Hospital within hospital LTACHs are physically located inside of a short term acute care hospital and often look similar to a separated unit of the hospital. Free-standing LTACHs are LTACHs in separate buildings from short term acute care hospitals. LTACHs can be non-profit or for profit. They also can be associated with a health care system, post-acute care system, or a system of LTACHs.”

I can confirm that some LTACs are within a hospital but the majority of them are actually external and free-standing and in some states in the United States, they’re even trying to send patients hours away from their families to go to an LTAC which sometimes can be two hours, three hours, five hours away, sometimes in a different state. It borders on insanity in my mind if hospitals are doing that.

So, the Wikipedia page continues:

Payment.

“The payment system for the services provided by LTACHs is complex. Medicare reimburses for LTACH services through the Prospective Payment System (PPS). Payments are based on an average patient length of stay in the LTACH of 25 days. LTACHs receive an adjusted DRG (Diagnosis-Related Group) payment for patients. Generally, LTACHs have higher reimbursement rates and higher operating margins than traditional short-stay hospitals, which in part reflects the higher cost of care for patients with complex care needs.”

Now, there’s one very important sector in the payment section here on the Wikipedia page. It says an average patient length of stay in the LTAC is 25 days. Now, pretty much not what we are seeing here at intensivecarehotline.com because most of our clients are very complex and it’s certainly not what we are seeing, but here is what is important around these 25 days averaging of stay what they’re saying, but they’re not really giving a lot of detail around that.

Well, I can share some details with you. So, when patients are “being sold” on going to an LTAC from an ICU, they are being told that LTACs are specialized on weaning patients off ventilation and tracheostomy. Now, from my perspective, no LTACs is specialized on that because the outcomes that patients are getting in those LTACs are not good. And again, there’s so many case studies on our website that you can read around that where we get firsthand information from families. I’ve spoken to many LTACs over the years on the phone, on video calls, zoom calls, team calls and whatnot. The skill level that you get in an LTAC is very low, very, very low. No ICU nurses, no ICU doctors, no specialist nurses, no specialist doctors, which is why the outcomes are so poor.

The Wikipedia page will go in more detail in a minute, but I just want to focus on the 25-day rule or the 25-day average length of stay. So, patients go from ICU to LTAC, families are under the impression their loved ones are getting weaned off the ventilator in LTAC, and then they realize nothing’s happening for the first two weeks. LTAC is making excuses, “Oh, we’re just getting to know your loved one, and once we get to know your loved one, then we start with the weaning.” And then after two weeks of no weaning, they’re saying, “Oh, after 30 days, if they still haven’t been weaned, then they need to go to a Skilled Nursing Facility or a SNF,” and then things will get worse.

If in LTAC you have a 1:4 or 1:5 nurse to patient ratio, coming from an ICU where there’s a 1:1 or 1:2 nurse to patient ratio, in the Skilled Nursing Facility, it’s 1:10. So, it’s a downward spiral. Once you leave ICU go to LTAC, you’re setting off a downward spiral and the hospitals are telling you that, “Oh! LTACs are specialized on weaning off the ventilator.” You need to know what you sign up for, which is why I’m making these videos here so that you can actually know that the system is broken, and the system is flawed on all ends because they are set up for failure.

Now, let’s continue with the Wikipedia page:

LTAC quality reporting

The Wikipedia page says, “The Affordable Care Act requires LTACHs to report several quality measures as set by CMS. New quality measures go into effect each year on October 1, the beginning of the federal fiscal year. A list of quality measures and the year of implementation can be found. If LTACHs do not report the quality data, they receive a 2% reduction in their CMS payment.”

Next Wikipedia heading is:

Criticisms.

“Patients needing extended care and their families are often told LTACHs provide superior care, but the evidence is limited.”

That’s what I’ve been saying here for many years. Families are told that LTACs are highly specialized institutions for long-term ventilation weaning. Nothing could be further from the truth, it’s not even the better version of a nursing home. A critically ill patient goes from ICU to LTAC has ICU nurses, ICU doctors, respiratory therapists, everything that’s needed for someone on a ventilator.  And then they go to LTAC, there’s no more ICU nurses, no more ICU doctors, the pulmonologist might come once a day, the patients often don’t have weaning plans. That’s another thing we’ve seen with our consulting and advocacy and reviewing medical records and talking to LTACs directly. They have no weaning plans. How can you wean someone off a ventilator without a weaning plan?

The Wikipedia page continues.

“There is some criticism surrounding the frequency with which patients develop serious infections in LTACHs, which can occur three times as much as in conventional hospitals.”

Well, I’m not surprised that Wikipedia has that information. Also, what we see over and over again, patients go from ICU to LTAC, and they bounce back into ICU within 24 to 48 hours. We are not so not surprised because they shouldn’t be going into LTAC in the first place, but here is what gets worse.  So, let’s just say your loved one is in hospital A in Los Angeles, goes to an LTAC, they bounce back with two ICUs within 24 to 48 hours because they should not have been discharged to begin with, they’re going then back to ICU B in hospital B. So that means your loved one goes from ICU to LTAC to another hospital ICU within 24 to 48 hours. That is madness and is not patient and family friendly.

Next, well, let’s carry on. I’m not surprised that LTAC has a higher infection risk and I’ll tell you why. Again, the staff there are nowhere near as skilled and trained as in ICUs, not surprised that they wouldn’t even know how to prevent infections. A ventilated patient with a tracheostomy and a PEG tube needs a 1:1 nurse-to-patient ratio, 24 hours a day, with a critical care nurse. That is evidence based, not pulling this out of thin air. That is evidence based and you can look up the evidence at intensivecareathome.com on the Mechanical Home Ventilation Guidelines.

Let’s carry on with the Wikipedia page.

“Long-term care hospitals, which have grown rapidly in the last 25 years (1996-2021?), are cited as having almost twice the number of Medicare violations as standard hospitals…”

Once again, people there are violating the care and treatment of patients and families, and I’m so not surprised to read that on a Wikipedia page. I’m glad Wikipedia has done their research because it pretty much confirms what we’ve been seeing. We’ve been consulting and advocating here for families in intensive care since 2013, pretty much correlates with what we’ve been seeing.

So again, LTACs are cited as having almost the number of twice the number of Medicare violations in standard hospitals, “…and also have higher incidents of bedsores and infections.”

Again, no surprise because if you’re going from a 1:1 nurse to patient ratio in ICU to 1:4, 1:5, 1:8 overnight, there is no time to do the work for pressure area prevention. So it’s no surprise to me that this is all documented in a Wikipedia page.

“Other criticisms include the motivation for transferring patients to LTACHs and the timing surrounding patient discharge from LTACHs, which appear in part to be based on financial considerations stemming from the complex LTACH payment regulations in the United States.”

Again, I can only confirm what the Wikipedia research is showing here because what’s happening is, once again, it’s about timing, it’s not about clinical necessity. It’s about timing.

So, here’s what we’ve seen over and over and over again for our clients in the U.S. Patient in ICU gets a tracheostomy, then they get a PEG tube, and then the next day, families get told, “Oh, now that the one has a tracheostomy and the PEG, we should send them to LTAC, and we will send them tomorrow.” The patients and families have no idea that this was coming. They had no idea.

So, now probably what’s happening from a payment point of view, Medicare might pay less for an IC U bed after certain days, even though most Medicare patients are entitled for 60 days in ICU. But the sooner the ICU can get the patient out, the more cost-effective and the more profit the ICU probably makes because they can get a new patient in, and they can probably get more revenue. So, it’s all based on payments, it’s not based on what is clinically sound or clinically appropriate.

Next, then like I said in the beginning, it’s all confirmed here that then after 30 days, they want to send your loved one out from LTAC to a Skilled Nursing Facility, and no one neither in ICU nor in LTAC has made serious and genuine attempts to wean your loved one off the ventilator, no mobilization; we hear that over and over again.

Here is an ideal scenario:

Number one, the ICU should be working on avoiding a tracheostomy from Day 1. So, your question when you have a loved one in IC U is, what is the ICU doing to avoid the tracheostomy at all costs? What are they doing to wean your critically ill loved one off the ventilator and the breathing tube? Without the shadow of a doubt, that is probably your most important question.

Now, if a tracheostomy can’t be avoided, your next question is, what’s the weaning plan to wean off the tracheostomy and the ventilator? What’s the weaning plan? And those weaning plans, the best place to implement them is in ICU because all the skills and knowledge and know-how is in ICU to wean a patient off the ventilator, it is not in LTAC.

So, I’m really glad that Wikipedia is very much in line with what we’ve been broadcasting here for over 10 years that LTACs are a scam and that they have been built to shift money around, but they haven’t been built for a patient and the family’s best interest, especially patients are being sent to LTAC hours away from their loved ones from their families. Unbelievable!

I’ve been working in critical care for nearly 25 years in three different countries where I also work as a nurse manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care here at intensivecarehotline.com since 2013. We’ve been helping so many families. We’ve been saving lives for our clients. You can verify that on our testimonial section as well as on our podcast section where we’ve done client interviews.

That’s one of the many reasons we have been creating a membership for families in intensive care where you can become a member of and we will answer your questions in the membership by you going to intensivecarehotline.com, click on the membership link or go to intensivecaresupport.org directly. We’re building a community there for families in intensive care because if you think you can take this up with intensive care teams by yourself, I can tell you, you will be fighting a losing battle. Many families come to us when it’s too late. You are in a once in a lifetime situation that you can’t afford to get wrong, and you need the insights from the experts that have worked in critical care for decades. We can help you with giving you all the insights and getting you all the results at intensivecarehotline.com in our membership.

In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have personally written and recorded that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

I also offer one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you. I’ll talk to you and your families directly and handhold you through this once in a lifetime situation that you can’t afford to get wrong. I also talk to doctors and nurses directly and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. Once again, I’ll make sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment.

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to support@intensivecarehotline.com with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.